Risk-stratification in thoracic aortic surgery: should the EuroSCORE be modified?
Risk-stratification in thoracic aortic surgery: should the EuroSCORE be modified?
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DOI：
10.1016/j.ejcts.2004.01.003
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发表时间：
2004-05-01
影响因子：
3.4
通讯作者：
Carrel, TP
中科院分区：
文献类型：
--
作者：
Barmettler, H;Immer, FF;Carrel, TP
目的：心脏外科手术的风险分层是主要的兴趣。最近的研究表明，EuroSCORE是CABG和瓣膜手术中非常好和可靠的风险分层评分。本研究旨在评价接受胸主动脉手术患者的EuroSCORE。研究方法：367例连续患者接受胸主动脉手术，并根据加法和逻辑EuroSCORE算法进行评分。我们比较了预测和观察到的死亡率的相关性，并评估了EuroSCORE的修改，以改善评分系统。通过计算受试者工作特征曲线下面积（ROC）评估评分有效性。结果：总住院死亡率为10.1%。3-6%风险的EuroSCORE预测死亡率为2.3%，7-8%风险的EuroSCORE预测死亡率为12.9%，9-12%风险的EuroSCORE预测死亡率为18.4%，风险> 12%的EuroSCORE预测死亡率为27.3%。3-6%风险的改良评分预测死亡率为1%，7-8%风险为8.2%，9-14%风险为12.1%，15-24%风险为18.6%，风险> 24%为28.6%。ROC曲线下面积在EuroScore中为0.68，在改良评分中为0.91，在logistic模型中为0.72和0.86。结论：考虑到主动脉夹层（6分）和术前灌注不良（12分）的改良评分显著提高了EuroSCORE对接受胸主动脉手术患者的预测价值。(C)2004 Elsevier B. V.保留所有权利。
Objectives: Risk-stratification in cardiac surgical procedures is of major interest. Recent studies have shown, that the EuroSCORE is a very good and reliable risk-stratification score in CABG and in valve surgery. The aim of the study was to evaluate the EuroSCORE in patients undergoing surgery on the thoracic aorta. Methods: Three hundred and sixty-seven consecutive patients underwent surgery of the thoracic aorta and were scored, according to the additive and logistic EuroSCORE algorithm. We compared correlation of predicted and observed mortality and evaluated a modification of the EuroSCORE in order to improve the scoring system. Score validity was assessed by calculating the area under the receiver operating characteristic curve (ROC). Results: Overall hospital mortality was 10.1%. Additive EuroSCORE predicted mortality was 2.3% for 3-6% risk, 12.9% for 7-8% risk, 18.4% for 9-12% risk and 27.3% for a risk > 12%. The modified score predicted mortality was 1% for 3-6% risk, 8.2% for 7-8% risk, 12.1% for 9-14% risk, 18.6% for 15-24% risk and 28.6% for a risk >24%. Area under the ROC-curve was 0.68 for the EuroScore and 0.91 in the modified score, 0.72 and 0.86 in the logistic model. Conclusions: The modified score, taking into account aortic dissection (6 points) and preoperative malperfusion (12 points) significantly improves the predictive value of the EuroSCORE in patients undergoing thoracic aortic surgery. (C) 2004 Elsevier B.V. All rights reserved.